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Breathless and uncomfortable but peak flow ok?

Stupid question time from yours truly.

My best peak flow so far (and I'm still doing the regular readings for the asthma nurse to diagnose) is 410. That is an evening reading when it should be at its best anyway. I've had a run of really good days and have been able to get on and do most things without any symptoms.

But today I feel breathless and so, so tired yet my peak flow this morning was one of my best yet at 390 for a morning reading.

Can you feel rubbish and still have a good peak flow? Doesn't make sense to me if you can but I'm no expert!

Any input someone?

13 Replies


I'm not an expert but i am a long-term asthmatic. In my personal experience my pf rarely drops even when i'm feeling at my worst. My main symptom is a bad cough and my theory is that because the pf meter only needs one big puff out i can do that - even if it does mean it'll make me cough even more afterwards.

There's only once when i went to ooh doc and he told me to quadruple my normal i puff dose of preventer (i'd already doubled it to 2 myself) and could use my reliever up to every 2 hours before i had to start thinking about hospital - my pf was STILL unbelievably 90% of my best :-o

Ah, the title of this post sounds SO familiar! I get that too - I've almost given up on PF as a reliable guide, though have also been told I don't do it right. Even after getting technique right though, it STILL makes no sense and I prefer to go on things like how much reliever I need and how long I can leave it between puffs. So I'd say if you're struggling, you should listen to that not just the numbers. Hope you get some more good days soon - it does seem to happen like that!

I have been told by the AUK nurses and I think by a consultant that PF only measures whats happening in the larger airways, and that if you have issues with the smaller ones then PF may not be affected so much. Unfortunately a lot of the drs/nurses I see still place a lot of emphasis on PF which can be a bit annoying when I know I'm struggling because I need lots of reliever but PF is ok (jinglfairy wish I had your OOH dr). I know for some people it is a reliable guide but judging from this and other posts here, not for everyone! I'm not any sort of expert either but I reckon if someone was having lots of reliever but struggling to talk etc I'd be calling them an ambulance even if they could do a decent PF!

I've also found that at times (not always and not everyone) they can go on absolutes which is annoying, instead of personal bests - so they say it's fine, but I think 'well yes, if my best really was 470 like I'm predicted 450 would be great, but as it's actually 600 I can't see that 450 is brilliant even if it's not terrible - you wouldn't be saying it was a great PF if you had some bloke in with a predicted best of 600, you'd be telling him he's in the yellow zone!'

Pufferbelly profile image
Pufferbelly in reply to

I have the same issue. My pf shows normal range, but I am full of mucous, coughing, and feel terrible-mostly very tired- and without a fever or other symptoms. So glad to find out I am not insane! Thanks for sharing your experience.

Wife is getting that problem at the moment. Shes been ill for months. Pregnancy seems to have made it worse.

Stupid consultant is now saying that because her peak flow is OK (400 I think) then her asthma is ok. As such it must be a virus. Nice one - for 2 months !!!!

Vebb profile image
Vebb in reply to

Hi, I was wondering if your wife ever found out what was wrong? My Peak Flow is my personal best, but I feel out of breath and the bronchodilator only gives me short term relief. My doctor also suggested maybe "virus" but it feels like it has gone on too long without any other viral symptoms. (I am not pregnant, though.)

I have this problem a lot! I've had drs try to discharge me from a&e because my peak flow was 350 (I usually sit at around that on good days) when I was still having an attack. Lucky for me another dr came round and put them straight and good job he did because I went down hill pretty quickly and was quite ill! (But that's another story)

I think they emphasise to much on it as its one of the only ways they have of measuring it but I've been feeling really good and my pf is low and vice versa there's to much variables on it, and when you feel rubbish and a dr says ohh but your pf is fine it's really Frustrating. I had a consultant say I was having a panic attack before because of my pf. It's so emotional having an attack or issues hearing these kinds of things I started to think I was. Until they did blood gas and changed their mind pretty quick! Guess it does a job or they wouldn't use it but I get really nervous of it these days.

Vebb profile image
Vebb in reply to cconsta1

Hi cconsta1, how did they treat it? And did they have an answer as to why it was like that? I'm having the same problem. Been feeling badly short of breath but my pf is great.

I've been keeping a record of my PF since last time I was really unwell, when it was somewhere between 250 and 300 and although I'm not 100% certain that it's much use in the short term I can see that it crept up over about 12 months to between 400 and 450 so maybe it's more useful to track longer term changes. Interestingly, it is now between 430 and 490 (my best ever - round of applause for my lungs)although I'm still doing a bit of coughing in the mornings. I can see no reason for the increase except that my stress levels have reduced dramatically since my mum died last year and I'm no longer having to rush to the home or A&E in response to another crisis, so maybe it is also useful for identifying the overall state of health, both physical and emotional. Just a thought, but I'd be interested to hear what other people think.

Sorry, Paulfoel, that ramble doesn't really help you much, but I'm finding that I'm using the numbers more as an early warning of trouble on its way than as confirmation that I've already got a problem, but that's just how it seems to be working for me at the moment and it could all change tomorrow!

Anyway, I hope things look up for your wife soon.

Found that too - peak flow OK and doctors immediately think asthma is fine.

My wife also got told it was pregnancy related stress which was a bit off. As explained, it looks like it might have been infection now which makes it look like asthma.

Fingers crossed.

BTW - whats a good peak flow? Or is it different for everyone?

So since you can measure peak flow and SATs are unreliable at what point do you go to hospital? I guess when you feel you can't breathe....

in reply to

BTW - whats a good peak flow? Or is it different for everyone?

So since you can measure peak flow and SATs are unreliable at what point do you go to hospital? I guess when you feel you can't breathe....

Peak flows vary for everyone, based on gender, age, size, and lots of other variables. What is important is *your* personal best PF as this is the yardstick used to know when things are deteriorating, and on asthma management plans.

A personalised asthma management plan should tell you what to do if your PF deteriorates, whether thats increasing steroid inhalers, starting oral steroids, or seeking GP or emergency help.

I wouldnt recommend anyone making their own judgements merely based on 02 sats. They give you one measure, and sats monitors are notorious for being inaccurate, particularly cheaper ones. People are also not that great at understanding how to use them or the variables which affect readings. They dont tell you what your Co2 levels are doing either - 02 sats can look normal when C02 levels are not.


cheers lynda. thanks for all the kind assistance....

Hi Paul

How r u?

I've been like this for a while now.

I've had asthma since I was about 5 (now 40) and its usually well controlled.

Since I went onto seretide 500, I can usually get 750-800 on my PF (I'm 6' 3"" and roughly 14.5 stone), but now it's anything from 500 to 690 max.

Been telling docs for nearly 2 years!

Currently waiting on referral.

Feel knackered most of the time, even though I get my 8 hrs a night roughly.

Also feel as if I've had a permanent cold !?

Hope u get sorted soon.

Hello! Same issue here! I got called into my doctors in Augast as during my asthma review I said I had been feeling breathless and rely on my blue inhaler morning and night!

I have had a chest X-ray which came back fine, the doctor said she would look into it and speak to a specialist. She then rang me back and said that it's weird that I have issues with my asthma as I hit 500 on my peak flow regularly and has asked me to keep a diary of it... Which I know will be 500 give or take!

It is frustrating the way they say it is like well there can't be anything wrong, your peak flow is fine. I started thinking it was all in my head! Reading all your comments has made me see it's very common!

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